PRACTICUM EVALUATION TOOL TEMPLATE

DEPARTMENT OF NURSING
JAMES MADISON UNIVERSITY
Student:

Lawler, Emily

Name of Preparer:

Melissa Leisen/Gleason

Practicum Site:

Well child experiences, UVA Medical Center and

Precious Time family homes

Course #: NSG
451L

Section #: 2

Date:

12/1/15

CLINICAL HOURS

Direct Patient Care:34

Simulation:3

Observation:0

Missed Clinical Hours:0

Precepted:0

Other:8

Grade

Total Clinical Contact Hours:45

Criteria: Students must achieve a passing rating in every outcome in order to pass a practicum course

Pass

Demonstrates satisfactory development of knowledge and skills. Objectives are met consistently and comprehensively, with progressive
independence and self-direction. Shows insight into strengths and areas for growth.

Fail

Mastery of skills and objectives inconsistent. Conduct is unsafe, unprofessional, offensive, or fails to maintain therapeutic alliance with clients
or resource personnel. Fails to construct or submit documentation in a professional or timely manner.
Outcomes/Objectives

Rating
Pass/Fail

Health Promotion/Illness Care: Provide health protection and promotion, risk reduction, disease prevention, illness
care, rehabilitation, and end of life care to diverse populations within a holistic framework in a variety of settings.
1.

Course Objectives: 2, 3, 4 & 5

Behaviors:
Identifies and/or implements developmentally appropriate health teaching based on patient and family needs.
Provides nursing care to children with acute and chronic conditions based on medical orders and established nursing plan of care.
Provide safe nursing care following agency policies.

PASS

Student Name: ___________________________________________

NSG Section ____

Page 2 of 4

2. Critical Thinking: Synthesize knowledge, skills, and technology from the established practice and science of nursing,
the biological and psychosocial sciences, and the humanities to engage in critical thinking, clinical reasoning and the
nursing process in the care of clients.
Course Objectives: 4 & 5
Behaviors:
Demonstrates ongoing comprehensive knowledge of child/family based on data collection.

Performs pediatric developmental, physiological and psychosocial assessments in a timely manner.

Implements developmentally appropriate interventions individualized for the child and family.
Analyzes and interprets patient data as demonstrated by written and verbal integration of pathophysiology, diagnostic tests,
medications and lab results.
Identifies and prioritizes appropriate nursing diagnoses using NANDA.
Establishes SMART (specific, measureable, achievable, relevant, time bound) goals and related interventions.
Evaluates effectiveness of interventions.
Identifies and immediately reports data which deviates from normal to appropriate staff and instructor and keeps instructor informed
of changing patient needs.

PASS

3. Therapeutic Relationships: Develop caring culturally competent relationships with clients that are sensitive to diverse
personal, socio-cultural, and environmental characteristics, which encourage clients to assume primary responsibility for
health care decisions, and in which the nurse functions as advocate and advisor.
Course Objectives: 1, 3, 5, & 6
Behaviors:
Develops individualized plans of care, incorporating family structure, family dynamics, and home environment.
Implements independent and collaborative nursing interventions based on family and childs needs.

Provides developmentally appropriate play, communication and diversional activities to children.

Demonstrates sensitivity to culture, ethnicity, and religious beliefs through advocacy and respect for family decisions.
PASS

4. Communication: Use effective communication and information technology to communicate interpersonal and health
care information.
Course Objectives: 1, 3, & 6

Behaviors:
Communicates and listens effectively to family and child, incorporating developmental considerations and diverse needs.
Charts assessment and medications administered accurately and in a timely manner.
Keeps appropriate staff and instructor updated on activities performed and patient status, utilizing SBAR (situation, background,
assessment, recommendations) or IDEAL (Identify with 2 identifiers; Diagnosis and Current condition; Events or recent changes in
condition; Anticipated changes, what to watch for; Leave time for questions & clarification) format.
Interacts professionally and positively with instructor, staff, patient, family and peers.
Uses technology effectively and professionally only when required for patient care.

PASS

Student Name: ___________________________________________

NSG Section ____

Page 3 of 4

5. Professional Role Development: Enhance professional role development.

Course Objectives: 1, 3, 5, & 6

Behaviors:
Prioritizes and manages the care of 1 -2 pediatric patients and their family.
Demonstrates effective time management.

Demonstrates safety and competence in calculation, preparation and administration of medications to children
Can perform nursing skills with an understanding of their underlying concepts.
Accepts responsibility for RN role development.
PASS

6. Ethical and Professional Values: Engage in activities to promote self-awareness, self-growth, ethical accountability,
and legal responsibility in the practice of nursing.
Course Objectives: 6

Behaviors:
Respects the child and familys privacy and confidentiality.
Assists staff and peers when needed.
Identifies individual learning needs on an ongoing basis and seeks validation of strengths and weaknesses from instructor.
Documents in a legal, ethically sound, professional manner.
Accountable for mistakes.
Accepts constructive feedback.
Follows JMU and agency dress code.
Punctual
Adheres to agencys policies.
Current Practicum Documentation maintained.

PASS

7. Scholarship: Contribute to excellence in nursing care by scholarly contributions through discovery, integration,
application, and teaching. Contribute to excellence in nursing practice by identifying and critiquing research evidence
and integrating it with clinical practice, patient preference, cost-benefit, and existing resources.
Course Objectives: 2, 4, & 5
Behaviors:
Uses resources to promote learning and seeks out new learning opportunities.
Brings information to clinical for student/staff dissemination.
Evidenced based research presented in practice.
PASS

Student Name: ___________________________________________

NSG Section ____

Page 4 of 4

Areas of strength:
Provided developmentally appropriate communication and diversional activities to children while conducting vision screenings at a high

school. Appropriately addressed students based on their age and treated them respectfully.
Respected the adolescents privacy and confidentiality.
Assisted staff and peers when needed.
Accepted constructive feedback.
Worked well with peers and RNs on the unit
Willing to assist others as needed.
Able to gain trust of her patients by using play

Areas for growth:

Ask more questions!

Be patient with yourself when you graduate. It takes time to feel proficient.
Be cognizant of what is going on with your patients. We could have had a big problem if the child on Day 1 had pulled out his central
line!
Proof read your writing. Multiple spelling errors on your journal.

Skills performed: Attended Epic training and had a good grasp of the system. Cared for a 4 year old with
developmental delay, short gut and congenital issues, and a 4 week old with fever. Worked in a contact isolation setting
with good technique. Performed vital signs, PEWS, safety, pain, I & O, GCS, and an assessment. Swaddled and fed a
baby. Charted adequately on Sim Chart and Epic. Assisted with central line dressing change.
MCAST final grade: 100
All Precious Time requirements completed and achieved a grade of 70% or higher:
This Practicum Evaluation Tool (PET) reflects a passing grade contingent upon successful completion of all Precious Time clinical hour and
paperwork requirements. The faculty will update the PET once all the requirements have been made. If not all requirements are met by
December 5th, the student may receive an incomplete or a clinical course failure dependent on the nature of the circumstances of not meeting
course requirements. Faculty will advise the student if the requirements are not fulfilled within the designated timeframe.

Simulation Pass/Fail: Pass

Final Grade:

PASS